Cardiotocogram compared to Doppler investigation of the fetal circulation in the premature growth-retarded fetus: Longitudinal observations
Cardiotocogram compared to Doppler investigation of the fetal circulation in the premature growth-retarded fetus: Longitudinal observations
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DOI：
10.1046/j.1469-0705.1997.09030152.x
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发表时间：
1997-03-01
影响因子：
7.1
通讯作者：
Hackeloer, BJ
中科院分区：
文献类型：
--
作者：
Hecher, K;Hackeloer, BJ
我们的目的是比较计算机化胎儿心率分析与宫内生长迟缓胎儿动脉和静脉循环的血流速度波形分析。我们报告了五个说明性案例，对妊娠 23 至 32 周之间的胎儿多普勒结果和胎儿心率进行纵向观察。记录脐动脉、大脑中动脉、降主动脉、静脉导管和下腔静脉的血流波形。胎儿心率根据道斯-雷德曼标准通过计算机系统进行分析。每个胎儿的恶化时间顺序均单独描述。在胎儿心率异常低的短期变化之前，心房收缩期间静脉导管波形的搏动突然增加，并伴有前向流速的损失。对于高胎龄和伴随的母体疾病，我们在正常多普勒测量的 12 小时内观察到流速波形的严重改变，这与妊娠中期的发现形成鲜明对比，在妊娠中期发生宫内死亡之前的几周内观察到严重异常的静脉波形。在具有终末期低短期变异的胎儿中，尽管心电图 (CTG) 异常，但正常的静脉波形表明胎儿健康。我们挑战了当前的概念，即 CTG 是确定早产生长迟缓胎儿选择性分娩最佳时间的最佳可用参数。静脉导管血流恶化似乎先于 CTC 异常，因此预示着需要分娩。
It was our objective to compare computerized fetal heart rate analysis with blood flow velocity waveform analysis of the arterial and venous fetal circulation in intrauterine growth retardation. We report five illustrative cases with longitudinal observations of fetal Doppler findings and fetal heart rate between 23 and 32 weeks of gestation. Blood flow waveforms were recorded from the umbilical artery, middle cerebral artery, descending aorta, ductus venosus and inferior vena cava. Fetal heart rate was analyzed by a computer system according to the Dawes-Redman criteria.The time sequence of deterioration is described individually for each fetus. An abrupt increase in pulsatility of ductus venosus waveforms with loss of forward flow velocity during atrial contraction preceded abnormally low short-term variation of fetal hears rate. With advanced gestational age and concomitant maternal disease, we observed severe alterations of flow velocity waveforms within 12 h of normal Doppler measurements, which is in contrast to findings in the second trimester, in which severely abnormal venous waveforms were observed over a period of several weeks before intrauterine death occurred. In a fetus with terminally low short-term variation, normal venous waveforms indicated fetal well-being despite an abnormal cardiotocogram (CTG).We challenge the current concept that the CTG is the best available parameter to determine the optimal time for elective delivery of premature growth-retarded fetuses. Deterioration in ductus venosus blood flow seems to precede an abnormal CTC and thus heralds the need for delivery.